Q: In the two years that my boyfriend and I have been together, he has yet to orgasm! Not once! He is a healthy 33-year-old taking no drugs and little alcohol. He occasionally has difficulty maintaining an erection, but overall is doing well. I have tried getting him to see a doctor. He says he’s embarrassed. He doesn’t seem to give importance to my own frustration that I can’t pleasure him. I hate to think that there may be a remedy and he’s too proud and stubborn to attempt it.

A: Difficulty reaching orgasm is found in nearly 25 percent of women, but it’s much less common in men. Less than 5 percent of men have difficulty reaching orgasm and some may not have an orgasm at all. Although it’s much harder for a man to fake it, most men are incredibly shy about this problem. Inhibited orgasm may result in a lack of sexual fulfillment for the man and his partner. These negative effects can be compounded when the couple is attempting to get pregnant.

There are many medical causes for delayed or absent orgasm. They include surgeries in the abdomen or on the spinal cord and diabetes. The most common prescription drugs that prolong or disturb orgasms are certain types of antidepressant such as Zoloft, Paxil and Prozac. The most common substance that delays orgasm is liquor. But, in a healthy person with no neurologic problems and who takes no medications, the cause of orgasm difficulties is almost always psychogenic. In a recent medical article published in the Journal of Sexual Medicine, the authors concluded that men with orgasm problems expressed lower relationship satisfaction than other men. Not surprisingly, these men with inhibited orgasm also had higher levels of “fear of failure” when they were in sexual situations.

I recommend a man with orgasmic difficulties see his physician. Then, see a sexual health counselor to better understand whether there is an underlying personal or relationship issue that may be creating a blockage in the normal flow of emotions, feelings and sexual sensations that should typically culminate in orgasm.